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Referral Management Specialist

2 months ago

Bethesda, Maryland, United States Zimmerman Associates Full time
Job Title: Referral Management Specialist

Zimmerman Associates, Inc. (ZAI) is seeking a skilled Referral Management Specialist to support a government contract bid in the Bethesda, MD area. This is an onsite employment opportunity with consideration for teleworking after 120 days onsite.

Role and Responsibilities:
  • Review referrals to ensure accuracy, completeness, and appropriateness.
  • Collaborate with healthcare teams to ensure proper use of the Direct Care System and civilian network resources.
  • Ensure patients are scheduled timely, with the right provider, and at the designated place of care.
Qualifications/Skills and Experience:
  • Minimum of an Associate's degree and 2 years' experience in Utilization Management, Referral Management, Authorization/Denials, or Medical Claims Processing/Insurance Referral.
  • Knowledge of medical terminology and computer literacy to interpret and apply medical care criteria.
  • Effective communication and people skills, with a focus on customer service.
  • Excellent organizational skills, including time management, prioritization, and goal setting.
  • Knowledge of Microsoft Suite of Products, including Word, Excel, PowerPoint, Access, Outlook, and the Internet.
Essential Tasks:
  • Review referrals and ensure accuracy, completeness, and appropriateness.
  • Collaborate with healthcare teams to ensure proper use of the Direct Care System and civilian network resources.
  • Ensure patients are scheduled timely, with the right provider, and at the designated place of care.
  • Process referrals and ensure compliance with guidelines and regulations.
  • Communicate with patients, healthcare teams, and other stakeholders to ensure smooth referral processes.
Requirements:
  • Ability to work in a fast-paced environment and meet deadlines.
  • Strong analytical and problem-solving skills.
  • Excellent communication and interpersonal skills.
  • Ability to work independently and as part of a team.
  • Knowledge of healthcare systems and regulations.

ZAI is an equal opportunity employer. We are committed to diversity and inclusion in the workplace.